Provider Demographics
NPI:1093531360
Name:WHITE, EMMANUEL WALTHER JR
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:WALTHER
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3361 QUEEN CITY AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2215
Mailing Address - Country:US
Mailing Address - Phone:513-953-5259
Mailing Address - Fax:
Practice Address - Street 1:3361 QUEEN CITY AVE APT 11
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2215
Practice Address - Country:US
Practice Address - Phone:513-953-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide